Why Can’t I Get an Appointment with my GP?
A number of patients are complaining that it is difficult to get an appointment. We do not like to give poor service and are as concerned about this as you are but, despite trying a number of options we have not been able to solve the problem.
Why is it happening?
1. The biggest driver is increasing demand. The average number of times a patient attends the practice (on average) has increased from three times per year to eight times per year. This has occurred over ten years and is driven by a several factors listed below.
- The focus of medicine is now much more on ‘prevention of illness’ rather than just ‘treating an illness’. This means that people who have no symptoms of feeling ill are now encouraged to come to the surgery to ‘look for’ any signs of potential illness. Although this is what we all want and hopefully prevent illness, it means that more patients who would consider themselves well, have to have appointments for review.
- Guidelines are increasingly advising people to attend the surgery more frequently. For example: we have nearly 2000 patients with high blood pressure. The guidelines used to advise annual blood pressure checks but a couple of years ago this changed to advise twice yearly checks. Over night this increased the demand by 2000 appointments per year.
- The media run almost daily health stories that advise people to see their GP if they have any concerns. Although this obviously picks up some people who did not realise they were ill, it also creates a lot of demand from people who are concerned and make appointments but do not turn out to have the illness discussed.
- Society is getting older. Two thirds of the people who have ever lived to be older than 65 are alive today. This is great news as it means our life expectancy is improving but unfortunately as we get older we also tend to get more medical problems.
- Medicine can do more. Conditions that used to be fatal or untreatable are becoming less (Hurrah!) but this means more demand for appointments and care.
- A lot of social problems e.g. obesity/stress are being ‘medicalised’ and people are told to see their GP with the problem.
- Life is busier and we do not tolerate ill-health. Even short term illness can affect us financially and socially and understandably people do not want to be ‘patients’ for longer than necessary. This means that people frequently consult earlier than in the past. Sometimes they consult too early and need to be bought back for review as the pattern of their illness is not yet clear. Most illnesses will improve on their own and we are always amused when people come in and say ‘I was ill when I made the appointment but it was so long ago that now I am better’. This means that they did not need the appointment and raises the question why they did not cancel it when they got better!
- The hospital is discharging both in-patients and out-patients sooner and general practice has picked up all this work without any more funding.
- The hospitals also frequently tell patients to contact their GP if they have are having problems with a referral or to obtain results. This is not work funded in General Practice but which we frequently do as we understand your anxieties and do not like to see you sent from pillar to post.
- Employers are frequently telling their staff to see their GP for various illnesses or complaints that may impact on the patient’s job. Some of these are appropriate but some such as ‘return to work’ notes are not.
- Perception is sometimes different from reality. Although we offer a large number of appointments at different times of the day and even some Saturdays, people find it difficult to get time off to go to appointments. We frequently hear the receptionists offering people a number of appointments which the person calling cannot make. The individual then says ‘I can never get an appointment at your surgery’. We understand that employers make it difficult for you to get here sometimes (some of our elderly patients think we offer too many early appointments when it is difficult for them to get to the surgery by public transport) but, there is not an easy solution to this as everyone has different needs and we need to stretch resources to meet as many as we can.
- We have the highest number of patients registered with the surgery than ever before in the past. Although they will not suggest numbers for England, in Scotland and Northern Ireland they recommend around 1800 patients per full time partner, we currently have closer to 2200. Although we would like to close our list (like we used to), this is much more difficult as the people who award contracts have to ensure patients have choice of where to register and, as such, closing a list can only be a short term solution whilst other options are identified. For our practice, in an old building, these options are limited as discussed below under ‘Why not just have more GPs at the practice?’
Why not just have more GPs at the practice?
If demand is increasing you may question why the surgery doesn’t just create more appointments or employ/recruit more doctors. The simple answers are space and money.
- The practice is in an old building and we already ‘hot desk’ i.e. when a GP is not using his/her room, there are other people e.g. locums, registrars or midwives using the rooms. This means there is insufficient space to bring in a new doctor.
- To do alterations and increase the number of rooms in the current practice is not considered appropriate as this would:
· Decrease the available car parking.
· Invest in a building which is already struggling to meet Disability Access and Health and Safety requirements.
- Moving to a new, more suitable site has been discussed frequently over the years but rejected for the reasons below.
· We had an option to move into a new build at the ‘cattle market’ site near the railway. However, this would have only given us the same number of rooms that we currently have and would have meant that patients would have had to pay for parking as we would only have been allocated two disabled parking bays.
· We also considered moving to the Ken Marriot re-development but this does not have public transport near-by and would have meant patients would have had to struggle to walk from the town centre to the new practice (this is not great when you are feeling unwell!).
· Moving to a completely new site has also been discussed but as there is no appropriate site in the town centre we would need to move to one of the suburbs which once again would create transport problems for patients not in that suburb.
- Despite the successful campaign that we are all overpaid that the government has made, in reality GP income has decreased year on year since 2007/8. This is mainly because all expenses are rising faster than any small increases given by the government.
- Despite the income decrease, the GPs at the practice are working longer hours. A lot of this work is due to extra paper work created by the demand above. The demand of meetings and paperwork is likely to become even greater given the new Health and Social Care Act changes.
- It has been suggested that the current GPs offer more appointments. We each see 30 to 40 patients a day and do 2 to 4 home visits each as well as responding to messages and contacting patients with urgent results. We simply do not feel that we would be able to see more patients and still keep up our standards of care.
What have we done to try and manage the demand?
It is accepted that we will never meet the demand for appointments but we try to ensure we are meeting the need. There is no evidence that the increased demand and difficulty in getting an appointment has led to increased adverse health outcomes for individuals. However, we do try to ensure that patients who need assessment are seen. We have tried to do this as below:
- We employ two salaried GP's and have increased their hours over the years.
- We are fortunate at the practice to have excellent nurses who have done extensive extra training (PCPs) and can prescribe and diagnose most illnesses. As well trying to ensure the PCPs see self limiting illnesses, the PCPs also run a lot of our chronic disease clinics such as diabetes. One of our PCPs has recently started seeing some of our patients with high blood pressure to try and make more GP appointments available.
- We run a duty service where any medical problem that is thought by the patient to be urgent is assessed by a practitioner and an appointment made if required.
- We keep reviewing processes to see if we can offer services in another way e.g. recent legal changes meant that it was no longer necessary for patients to always have a face to face assessment in order to receive ‘fit notes’ for on-going illnesses, so we now have a paper based system which has led to a large number of appointments not being used to obtain these notes.
- We are currently looking at telephone appointments so that patients could ring in and arrange a time for the GP to call them rather than having to come up to the surgery. This is only in the early stages of assessment and we would appreciate your thoughts/concerns.
What you can do to help...
- Please do not shout at the receptionists. We fully understand your frustration but the reception staff cannot make appointments appear and, despite the comments that we hear, do not have favourite patients or hide appointments from some patients.
- Do not miss appointments. This may sound simple and most patients do not miss routine appointments. We know that confusion arises with letters and appointments at times but sometimes people just do not turn up.
· If you miss an appointment at the practice this means that appointment is wasted. Most people do not miss appointments with their GP but, more patients do not attend review clinics with the nurses and family planning appointments (each of these appointments is a ‘double’ which means four patients could have been seen in this time).
· If you miss your appointment at the hospital it is now policy to discharge patients if they do not show up and this requires you to be re-referred by the practice.
- Consider whether you need an appointment to solve your issue if it is not to do with your health. For example, if you have had a problem with your referral you can phone and speak to (or leave a message with) the practice secretary who will try and sort out your problem. If she cannot manage the issue, which seldom happens, she will pass it onto the appropriate GP.
- Ask the hospital
· For a prescription or ‘fit note’ whilst at your out-patient appointment or at the end of your in-patient stay. They are required to provide you with these and should not be sending you back to the practice.
· How they will provide you with your results. Although they send you to us this is in fact outside the General Medical Council guidance on good medical practice.